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PEDIATRIC ANESTHESIA

Confirmation of Direct Epidural Catheter Placement Using Nerve Stimulation in Pediatric Anesthesia

Susan M. Goobie, MD FRCPC^*, Carolyne J. Montgomery, MD FRCPC^*, Rahul Basu, MD^*, Jillian McFadzean, MD^*, Gerald J. O’Connor, MD FRCPC^*, Kenneth Poskitt, MD FRCPC, and Ban C. H. Tsui, MSC MD, FRCPC

Departments of *Anesthesiology and Pain Management, and Radiology, British Columbia’s Children’s Hospital and University of British Columbia, Vancouver, BC; Department of Anesthesiology & Pain Medicine, University of Alberta Hospitals, Edmonton, AB

Address correspondence to Susan M. Goobie, MD, FRCPC, Department of Anesthesia, Children’s Hospital, 300 Longwood Avenue, Boston, MA 02115. Address email to susan.goobie{at}tch.harvard.edu

We evaluated the success rate of using low current electrical stimulation (the Tsui test) to identify and confirm direct epidural catheter placement in a pediatric population. Thirty subjects received a standard anesthetic and administration of the Tsui test on epidural placement. The distribution of myotomal activity was recorded. The intended and actual level of the epidural catheter was compared. Myotomal activity was seen in all patients but one. The median current resulting in myotomal activity was 5.3 mA. The median difference between the intended and actual level as confirmed on radiograph was 1.8 levels. The clinical success rate was 93.9%. The positive predictive value of the Tsui test was 82%; i.e., in 23 of 28 cases, the Tsui test correctly identified the position of the epidural catheter tip within 2 vertebral levels. The test did not offer any added advantage when used in the setting of directly placed epidural catheters in our institution over "blind" methods already used to confirm catheter position when using cutaneous landmarks and test dosing.

IMPLICATIONS: A new technique to confirm epidural catheter position uses low current electrical stimulation in pediatric patients. This study evaluated the use of electrical stimulation in 30 pediatric patients for directly placed catheters. Electrical stimulation did not provide any advantage over conventional methods (e.g., cutaneous landmarks) for confirmation of catheter position.

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Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999